may find it in some children as a genetic defect , these children either wont have a clavicle or only part of one. They have very hyper mobile shoulders because of this. (Example; ends of the clavicle may form but there might be nothing but fibrotissue in the middle)

What are the 3 common places that Thoracic Outlet syndrome can occur and what causes it?

Thoracic outlet syndrom – a person who does a lot of overhead work or with people who hunch over a lot , this head forward posture can cause compression of all the nerves, veins and arteries which go through very small spaces on there way into the arm. There are three usual or common places were you find this happens.

Pathology: Head forward posture can also compress the back of the neck and lead to headaches due to the compression of the greater and lesser occipital nerve. This can happen to anyone who keep there head protrude forward a lot such as a secretary with bad posture.

Pec minor syndrome – the peck minor is shortened and pull down the coracoid process and compresses the vascular bundle. This can cause nerve tingling and

deadness and pain in the hand.

Used to be considered to be a vascular issue but (90% OF these disorders have nerve signs) now it is though to be more often a nerve issue and for some reason the ulnar nerve is the most commonly effected nerve.

What are the common tests for Thoracic Outlet Syndrome (peck minor syndrome)?

Roos test (EAST) - 1 of 2 most common test – stand for 'elevated arm stress test'. Have the patient raise their arms with there hands up and out to side and

move them back and forth.

Adson maneouver - 1 of 2 most

common test – palpate the radial artery normally and then have them ipsolaterally rotate and extend the arm and then palpate the wrist again and if it gets weaker and weaker and goes away they may have thoracic outlets test , this is an artery test.

Allen Test

Halstead maneouver

Common Test - The test for this is to have the patient lay on there back and if there shoulders aren't on the table then you know the peck minor been shortened and so the solution to this is stretching the peck minor.

What is Turner syndrome?

The patient has a single x chromosome and for some reason they have a very large carrying angle. Carrying angle is over ten dregrees.

Normal carrying angle is 10 degrees in men.

What is Keinbock's disease?

Caused by avascular necrosis of the lunate – patient will complain that they sprained there risk and if x rayed that day you can't see this , but a week or so later you can see the fracture on x rays.

What is trigger finger?

When the tendons going under the anullar or cruxiform ligament it catches in one of the gaps between the anular or cruxiform ligaments and this creates a snap when bent. In very bad causes the finger can become stuck due to this entraptment.

Scientific Explanation: Caused by thickening of a fibrous digital sheath on the palamar aspect of the digit produces stenosis of the osseofibrous tunnel, the result of repetitive forceful use of the fingers.

Leads to an inability to extend the finger and a snapping sound when it passively extended.

What is Bennett's Fracture ?

Break in the metacarpal of the thumb at the CMC joint has been smashed , which causes CMC disruption. This is caused by axial loading of the metacarpal, often caused by punching someone. Can't move the thumb due to pain.

What is Chauffer's fracture aka Hutchinson's fracture?

A cack in the radius and often this breaks of the styloid. It is caused when hand is forced into abd/adduction either through a compression fracture or a evolsion fracture

Name the most classic sign of a ulnar nerve leasion?

Claw hand

What is Ape Hand?

The atrophy of the muscles of the thenar eminence do to an Median nerve lesion.

What is bowlers thumb?

Repeatedly Sticking your thumb in a tight hole can cause Pinching of the digital nerves that goes around the outside of the thumb.

Define Games keeper thumb and skiers thumb and explain the difference between them?

Skiers thumb you tend to land and your thumb sticks in the snow and the height difference can rip the ulnar collateral ligament of the thumb tears.

games keeper thumb because the games keeper would ring a rabbits neck all the time the constant pressure day after day on the ulnar ligament causes it to become lose, or weakened.

What is Sweater finger or jersey finger and what is the most common test for it?

It is the Opposite of mallet finger.

This is whenan injury tears the tip of the tendon of the FDP off of the tip of the anterior side of the finger. Usually on the ring finger. Leaving DIP stuck in extension.

Test: have them make a fist and if they have this disorder then they can't curl the tip of the effected finger so they will have that finger sticking out of the fist. Do to lack of FDP.

What is mallet finger or baseball finger?

Caused – when your trying to catch a ball and your finger is out and you hit the finger on its tip and it is forced into flexion when it's in an extended position and this rips the extensor hood mechanism of the back and so the DIP goes into flexion because there nothing to hold it in extension.

Fix – splinting

What is Boutonniere deformity?

The finger takes on a W shape due to PIP in flexion , DIP in extension. This is due to the central slips of ED breaking of and the lateral sliping side way below the axis of the rotation which creates this position.

Fix – this can sometimes be fixed with splints and strengthening.

What is swan neck deformity? What causes it?

Can be caused by a break in the palmar plate, or by a weak FDS which can lead to a contracture of the intrinsic muscles of the hand which will pull on the finger so tight thast they pull the the tendon down. Normally this is stopped by the the FDS but if it is weak or non functioning it can't counter this effect.

In the human hand, palmar or volar plates (also referred to as palmar or volar ligaments) are found in

the metacarpophalangeal (MCP) and interphalangeal (IP) joints where they reinforce the joint capsules, enhance joint stability, and limit hyperextension. The plates of the MCP and IP joints are structurally

and functionally similar, except that in the MCP joints they are interconnected by a deep transverse ligament. In the MCP joints, they also indirectly provide stability to the longitudinal palmar arches of the hand. The volar plate of the thumb MCP joint has a transverse

longitudinal rectangular shape, shorter than those in the fingers.

Hand takes on a M shape – due to flexion of DIP and hyper extension of the PIP.

Fix – is always surgical, slpinting rarely works.

What is Carpal Tunnel Syndrome?

It is inflamtion of the Median nerve as it passes through the carpal tunnel with the FDP, FDS, FPL

What are the 3 most common tests for carpal tunnel system?

Phalen’s test – reverse prayer hand with dorsal surfaces of the hands pressed together , to check for pain.

Reverse phalen’s test (prayer) – prayer hands to strecth the heck out of the tendons so you hold it and see if it hurts

Tinel’s test – used on many nerves – you just find the nerve and you tap the nerve and see if it causes shooting pains, if it does then there is probably nerve damage. This works on superficial nerves to.

What are the symptoms of carpal tunnel syndrome?

First symptom is Tingling in the hand – mostly in the right side of the palm, in the first two finger and the thumb. Later on if it gets bad you get motor symptoms in the loaf muscles do to the impinging of the median nerve , in sever cases you get ape hand or atrophy of the thenar Eminence.

What is the most common symptom of a radial nerve lesion?

Wrist drop

What is ulnar drift and what causes it?

Your see this in rhematoid arthritis.The fingers drift toward the ulna

Why is a broken Scaphoid a problem, beyond the obvious?

When the scaphoid is broken it can look fine for a week or two before the break shows up, and this can lead to a malunion of the peices of the bone. For If the artery going to the schapoid dies you get avascular necrosis.

What is ulnar canal syndrome? What are it symptoms?

It is an impingement or compression of the ulnar nerve in the canal of guyon.

Symptoms: Hypoesthesia in the medial one and a half fingers and weakness of the intrinisc muscles of the hand. Clawing of the 4-th fingers which is hyper extension at the MCP joints with flexion at the proximal IP joints. However unlike in proximal ulna nerve injuries there ability to flex is unaffected and there is no radial deviation.

What are the symptoms of a laceration to the median nerve?

Paralysis of the thenar muscles and the first two lumbricals Hence opposition of the thumb is not possible and fine control movements of the 2nd and 3rd digits are impaired, sensation may also lost over the thumb and adjacent two and half fingers, on the palamr side of the hand.

What is Handlebar neuropathy?

It is a compression of ulna nerve due to repeated pressure on the hook of hamate from bike riding grip.

Loss of sensation on the medial side of the hand and weakness of the intrinsic hand muscles.

What is Dupuytren’s Contracture?

Dupuytren’s Contracture - the palmar aponeurosis can shrink and pull the fingers into the palm , we don’t know why this happens – this causes the fourth and fifth digit start to flex. Is painless and more common in men (10 times more likely in men then women) , most often in people with northern European ancestry, Also usually occurs in people over the age of 50. Splinting only works half the time with this issue so usually to fix this they due surgery they cut the aponeurosis bands (sometimes they will grow back and start to cause problems again) this can be done with a needle now, which prevent the need to cut into the palm.

What is Volksman's ischemic contracture?

Volksman's ischemic contracture- is something you see in the hand or wrist due to loss of blood supply. However this is not caused by radial artery damage , this is usually caused by cutting the brachial artery and depriving the forearm of blood, within a short time the hand does this. This can be permanent.

What causes carpal tunnel syndrome?

Inflammation in the carpal tunnel can be caused by anything that cause a lot of wrist action such as extension/flexion, so griping , typing or other action that require wrist motion.

Walls and components of the carpal tunnel?

Carpal tunnel

The lateral wall of the carpal tunnel is formed by the scaphoid tubercle and the trapezium tubercle and the medial border is formed by the hook of hamate and the pisiform bone.

Nine tendons go through the carpal tunnel with the median nerve - Tendons are

flexor digitorum profundus 4 tendons

flexor digitorum superficialis 4 tendons

flexor pollicis longus. 1 tendons – this tends to be the first effected by carpal tunnel syndrom so you drop things more.

What is Colles fracture and how does it happen?

Patholgoy - Radius tends to break due to FOSH injuries due to old age or osteprosis , it breaks below the head on the distal end of the radius (towards the hand before the big distal end) this is called the dinner fork deformities.

Or

Colles' fracture, also Colles fracture, is a fracture of the distal radius in the forearm with dorsal (posterior) displacement of the wrist and hand. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm. For a more detailed discussion see distal radius fracture.

What is Torticollis?

Torticollis – literally means twisted column – so it is when a person has wry neck or a twisted neck due to SCM spasms, it is seen in young infants. If an infant has this on this on the right side how would you stretch this muscle? Rotate to the right and side bend to the left , so this is the opposite action of this muscle, hence the best way to stretch.

What is Horner's Syndrome? and what are the 3 symptoms? How does this relate to lesions of the nerve roots?

Horner's syndrome – has three characteristics, miosis – a thick pin point pupil, or contraction of the pupil this is do to the failure of the SNS nerves that supplies the sphincter muscles around the pupil that open the eye, is disabled which causes the PNS to be unopposed so the eye stays contracted , anhydrosis – they don't sweet on one side of the face (can be both but is usually unilateral) , Ptosis – is the eye lid droops, because Sympathetic system runs the papillary muscle of the eye lid. Anything that damages inside the neck can cause this.

Side Note: Some times problems with the nerves

roots right by the spine can cause problems with the sympathetic nerve supply sense the sympathetic chain ganglion is right beside this. Most of the PS starts in the brain stem with the cranial nerves and the vagus nerve gets it to the body. This can cause various problems including Horner's syndrome.

What is the allens test (for arteries)?

Allens test – to see if these arteries are working you find these two arteries and then have the patient clench the hand tight a few times and then press the arteries down blocking them then the hand should turn white, then release them if the hand flushes with blood they work , if there is a delay then there is a problem with one or more arteries. Then release them one at a time to find out which one is the problem.

What is Biceptoradial bursa?

Biceptoradial bursa – sits beneath the biceps tendon and the radial tuberosity, to test to see if this bursa is inflamed you can pronate the elbow, (do this bilaterally to test both sides) (this will squish the bursa which will cause pain). This happens to people who do a lot of pronation and suppination such as screwing things in.

What is students elbow?

This is inflammation of the most commonly inflamed bursa of the elbow, the subcutaneous olecranon bursa which will swell up to the size of the egg.

What is Nursemaids elbow?

Nurse maids elbow = the annular ligament - keeps the head of the radius on the ulnar , this can be torn in kids and this is called nurse maid elbow. This happens when the radius is pulled out from under the ulna, happens when there arm is pronated and extend and then is pulled.

What age groups most commonly suffers posterior dislocation?

Posterior dislocation of the elbow – is common in children. Due to there tendency to take heavy fall on to flexed elbows which can break the coronoid process off the ulna.

What is the name of the Bursa that sits under the triceps tendon and the olecranon process and how can it become inflamed?

subtendonus olecranon bursa. - it can be inflamed if a person does alot of flexing and extending all day. If you passively flex the elbow and it hurts then this may be why.

What is the name of the most common manifestion of facial nerve proglems.

Bells palsy - this can be caused by many things including lime disease.

Define avascular necrosis?

Death without blood (in latin)

Explaine: Avascular necrosis of the Femur and the surgical repair method used in England?

Avascular necrosis of the Femur – if you have compromised femoral circumflex arteries this can occur , this is when the humerus dies from lack of blood vessels and then they have to do a hip replacement.

Surgical fix: In england they do a Surgery were they take out the fibula and drill a hole out into the top of the head of the femur and then they bang the fibula into the hollowed out femur and place all the bone chips in there , then they reconnect the arteries and then this bone regrows and remodels into the head of the femur, hence regenerating the the hip without having to have a full hip replacement.

Explain: Whip Lash?

Wip lash – Due to the forced hyper extension of the neck you can damage the anterior neck muscles of the spine in particular the deep muscles. In some cases the snap back can also damage some fo the muscles of the back of the neck.

Explain tennis elbow? List two test for this?

Tennis elbow (lateral epicondyleitis) – is inflammation of the common extensors tendon coming of the lateral epicondyle. Many people think its inflammation of the extensors carpi radialis brevis that is the primary cause of this. This can be caused by actions such as unscrewing or screwing things quickly for 20-30 minutes.

Test for tennis elbow – there are many tests for this, the one ben likes is the one were you are pushing down on middle finger when it is extended, if there is pain you have tennis elbow.

Define: Golfers elbow?

Golfers elbow – is the opposite of tennis elbow or medial epicondylitis. This muscle comes of the medial flexor tendon. The tendon most often implicated in this is the issue is the flexor carpi radilais (check this with classmates)

Common causes of lesion in th brachioplexuses

many of these lesions are stress or compression lesions and as such hopefully temporary legions. Legion in the roots or spine or vertebrea level can be degenerate joint disease or Osteophyte growth (hole shrinks with age and you get bony growths ) Can impinge on the nerve root itself . Can also get trunkor nerve problems.

What is Kiloh-Nevin syndrome?

Anterior interoseous nerve (supplies 3 muscles) can become impinged (this comes of median nerve before pronator teres) this goes to the PQ, ½ of FDP, FPL- entrapment of this nerve in the pronator quadratis is called Kiloh Nevin Syndrome.

More scientific answer:is a medical condition in which damage to the anterior interosseous nerve, a motor branch of the median nerve, causes pain in the forearm and a characteristic weakness of the pincer movement of the thumb and index finger.In a pure lesion of the anterior interosseous nerve there may be weakness of the long flexor muscle of the thumb (Flexor pollicis longus), the deep flexor muscles of the index and middle fingers (Flexor digitorum profundus I & II), and the pronator quadratus muscle. If asked to make the “OK” sign, patients will make a triangle sign instead. This 'Pinch-Test' exposes the weakness of the Flexor pollicis longus muscle and the flexor digitorum profundus I leading to weakness of the flexion of the distal phalanges of the thumb and index finger. This results in impairment of the pincer movement and the patient will have difficulty picking up a small item, such as a coin, from a flat surface.⁠⁠⁠ There is little sensory deficit since the anterior interosseous nerve has no cutaneous branch.

What is the test for Kiloh Nevin Syndrome?

Kiloh Nevin Syndrome -the pinch test - you have the patient make a circle with the thumb and index finger, if they make a triangle instead of a circle then you know the FDP and FPL has issues. This is because the the DIP or tip of the index finger is bent by the FDP which is innervated by the anterior interseous nerve and the thumb is bent by FPL which is also anterior interoseous nerve so this nerve bend the tips of these to digits. So if this nerve is damaged then you can't do this and so you use the abductor and flexors of the thumb and maybe the FDS to bend the finger down isntead

How do you determine if it is Kiloh Nevin or pronator quadratus impingement of the median?

To determine if the is Kiloh Nevin or pronator quadratus impingement of the median and the anterior interous nerve, you simply check the abductor brevis and oppones and the wrist flexors which are median nerve itself if they ok then its anterior interous only, but if you can't flex you wrist and have thumb issues it probably both impinged in the pronator quadratus. However if you have problems with wrist flexion and thumb movement but you can do the OK sign then it implies that it is the main branch of the median nerve.

Cubital tunnel syndrom (impingement in the collateral ligament) and Flexor carpi Ulnaris Syndrome (iminged in arcuate ligament) have the same symptoms because they occur so close together. How do you determine which is which?

Finkelstein test – is a test for de quervains disease or tenosynovitis. It involves tucking the thumb under the fingers and then deviating the wrist if this causes pain they may have tenosynovitis.

What are the common impingement sites of the median nerve?

Median nerve can become impinged in the pronator teres because it goes through a small hole between the two heads of the pronator teres into the forearm.

Most people don't have any place for impingement of the median in the upper arm but some some people have a ligament called the ligament of Struthers – this is a anomalus ligament which isn't normally in a person, it runs from the lateral humerus to the medial epicondyle and the median nerve and the brachial artery goes through this arch in some cases and this can be a site of impingement for median nerve.

Explain: Struthers ligament?

Struthers' ligament is a ligament that extends between the shaft of the humerus and the medial epicondyle of the humerus. It is not a constant ligament, and can be acquired or congenital. Its clinical significance arises form the fact that the median nerve, passes in the space between the ligament and the humerus, and in this space the median nerve may be compressed leading to supracondylar process syndrome

What are the signs and symptoms of median nerve impingement at the pronator teres?

The median nerve can impinge in the pronator teres because the median nerve goes through the pronator teres as does the anterior interouseous nerve (this nerve splits off proximial to the pronator teres.)– this is called pronator teres syndrome when the median nerve impinges there. Can be caused by a lot of pronation such as using screw drivers all day or other fast pronation actions. This can be tested for by resisting pronation with elbow flexion. This can also effect the thumb and mimic carpal tunnel syndrome but without the pain in the carpal tunnel or the.

How do you tell if it carpal tunnel syndrome or pronator teres syndrome?

Can test for the diff between carpal tunnel and pronator teres syndrome by having the person due wrist flexion, because carpal tunnel causes thumb issues were as pronator teres syndrome causes wrist and thumb issues.

What is Klumpke palsy?

Klumpke palsy– the opposite of erb palsy – C8 and T1 nerve roots may have been damaged this is caused when you stretch the lower nerve roots of the brachio plexus usually do to pulling on the arm such as in a fall. This can cause problems with the radial nerve and you may see the muscles flexed because there is no opposition from the triceps due to the C7 nerve root issues. If C8 is involved in this then there will also be issues with the hand due to the ulnar nerve being effected.

What is the cubital tunnel?

It is were the ulna nerve passes under the the ulnar collateral ligament.

How do you tell the difference between ulnar nerve impingement at the cubital fossa versus the canal of
guyon?

With a lesion in the canal of guyon everything before the canal is fine, but with an impingement at the ulnar collateral ligament FCU and 1/2 of FDP would be effected and so you would lose flexion of the 4-5 digits and wrist adduction would be weak. However with damage in either location you might see Froment sign.

What is Fromet

Froment's sign –a classic sign of ulnar nerve lesion – opposite of Kheln nevin syndrom – you ask a person to hold a piece of paper and then you pull it way and if they have ulnar nerve issues they will rip the paper. This is because they can't use abductor pollicis so they can't do a key grip because they can't abduct the thumb so they use the anterior interoseous nerve (branch of the median nerve) to flex the thum onto the paper instead of abducting the thumb this makes an O (pinching the paper) with index finger and the thumb instead of the normal pinched key grip and this may rip the paper.

What is crutch palsy?

Posterior cord lesion of the brachioplexus can be caused by crutches (crutch palsy) for a patient may let the crutch relax into the arm pit instead of holding the weight on the arm and this can damage these cords and lead to loss of wrist extension and elbow extension (skin sensation issues can result as well) this is because the radial nerve is the nerve usually effect by such lesions and Wrist drop is the classic sign of radial nerve damage.

Crutch palsy is called a posterior cord lesion so axillary and radial nerve, but in a cadaver the axillary nerve is much deeper (not at the end of the M as shown on brachio plexus diagrams) in hence why the radial nerve is the one more effected by crutch palsy.

The most common tears in the glenoid labrum are called slap (superior labrum, anterior) tear. Name the four most common slap tears? and the test for them?

Bankhart lesion – is a anterior inferior tear, happens near the bottom of the glenoid labrum

Hill-sach lesion – this is were you get a divot in the humeral head because it bashed up against the glenoid cavity.

Test: Palpitation can test for this.

If worked with a screw driver to much and you got an Impingement of at the suppinator of the posterior interoseous nerve what would be the symptoms?

Symptoms would be weak thumb extension. Probably wouldn't have wrist drop do to other muscle innervated higher up such as the longus and brevis muscle which can help.

What is the radial nerve?

Deep branch goes through groove (radial tunnel) in the suppanator (start of the tunnels is the arcade of Frohse which starts at the suppinator (it is a apeurnertoic arch which means it is tendinous or ligimentious arch where the nerve goes through) comes out of this tunnel as the posterior interosseous nerve also called the deep branch)

What is erbs palsy?

Erb palsy – is a lesion to c5, c6 and maybe c7, that a baby can get if head gets stuck during birth and the neck gets stretched, also applies to some neck injuries were the neck is stretched.

SAM – suprascapular, axillary, musculocutaneous, those three nerve take a lot of contribution from C5 , C6.

(Sam the waiter wants a tip p- because the arm will medial rotate the arm because the lateral rotators are gone so they stand like they want a back handed tip) this impairs flexion at the elbow, abduction at the shoulder and lateral rotation, because of teres minor and infrospinatus.

What might damage to C5,6,7 nerve roots?

Damage to these can effect the long thoracic nerve and the serratus anterior which can lead to winging of the scapula.

What is back pack palsy?

Damage to the superior trunk – can be caused by weight bearing on the shoulder. Such as a heavy back packs or carry a log on the shoulder. This can effect C5, C6 innervated nerves. Which can lead to things like atrophy to the pectoralis muscle do to damage to the lateral or medial pectoral nerve.

What is lexor carpi ulnaris syndrome?

The ulnar nerve passes through the two head of the flexor carpi ulnaris and as it passes through the arcutate ligament/tendon , and it can impinge in here as well. This is called flexor carpi ulnaris syndrome. The symptoms for this are the same as for when it impinges in the ulnar collateral ligament.

What are the symptoms of posterior interosous nerve impingement in the suppinator?

Sign or symptoms of posterior ineroseous nerve impingement in the supinator. No issue with suppintation for the suppinator and biceps are fine might cause weak wrist extension in MMT, but not full wrist drop but it would cause failure of many thumb movements do to the failure of abductor longus and the two thumb extensors

What is Benidiction sign or Bishops hand?

Bishops hand or benedictions sign – this is Extension of the MCP joints and flexion of the IP joints only of the 4 and 5 fingers.

When this oocurs during active grasp this is median if its caused when at rest then it's the ulnar nerve leasion

If it is ulna then it is due to the loss of the lumbrical and without them to resists motion it goes into this shape.

What is weavers bum?

Ischial bursitis - A person with ischial bursitis has inflammation of the bursa that lies over the ischial tuberosity. The ischial tuberosity is the bony prominence in the pelvis, on which you sit. The ischial bursa acts as a lubricating pad between tendons and the pelvic bone. The ischial bursa prevents destruction of the tendons as they move over the ischial tuberosity. A common cause of ischial bursitis is prolonged sitting. Inflammation around the ischial tuberosity can irritate the sciatic nerve, triggering symptoms that are very similar to acute sciatica.What are the symptoms of ischial bursitis?Symptoms of ischial bursitis include buttock pain or hip pain, and localized tenderness overlying the ischial tuberosity. Additional symptoms of ischial bursitis include numbness and tingling in the buttock that spreads down the leg. The symptoms usually worsen while sitting.

Ischeal tuberosity is the origin of the hamstrings and abductors hence why this bursitis is such an issue.